Healthcare Provider Details

I. General information

NPI: 1841099868
Provider Name (Legal Business Name): ISHMAEL MUHAMMED PHLEBOTOMIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2025
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3484 CEDAR CREST LN APT 202
WINSTON SALEM NC
27103-6860
US

IV. Provider business mailing address

3484 CEDAR CREST LN APT 202
WINSTON SALEM NC
27103-6860
US

V. Phone/Fax

Practice location:
  • Phone: 336-287-5036
  • Fax:
Mailing address:
  • Phone: 336-287-5036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberX6D2G2G4
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: